Improving Population Health: Ideas and Action David A. Kindig, MD, PhD
OUTCOMES DETERMINANTS/ Mean Disparity FACTORS Race/Ethnicity Health Care SES Mortality Individual Geography Behavior
Gender Social Race/Ethnicity Environment Health SES Physical Related Environment Quality Geography of Life Genetics Gender
POLICIES and PROGRAMS
improvingpopulationhealth.org David A. Kindig - April 2014 ntroduction to the Blog Collection Booklet
In 2010 I began a blog called ImprovingPopulationHealth.org. In the initial post I explained its rationale: bringI an overdue population health perspective to thinking about and acting on health and health improvement.
I ceased blogging almost a year ago, but the site continues to get a reasonable number of hits, and I frequently hear from a colleague about one of the ideas that appeared previously. I have therefore decided to publish this electronic collection of a sampling of these posts which I believe continue to have relevance. Most ongoing is expanding, often in variance with our original meaning. This is most evident in discussions from within the health CARE system, often as the third component of the Triple Aim. This set of blog posts offer a number of of Population Health, and Population Health Resources and Policy
three years. I owe much to her for her sharpening of ideas and clarity of writing, as well as valued colleagueship. of writing. I hope this reprinting will provide continued access to some of these ideas in the service of ongoing population health improvement.
David Kindig ~ April 2014
What is Population Health? ______Pages 1 - 8 Population Health Outcomes ______Pages 9 - 16 The Multiple Determinants of Population Health ______Pages 17 - 25 Population Health Resources and Policy ______Pages 26 - 33 What is Population Health?
Table of Contents
Is Population Health Finally Coming into Its Own? ______1
What is Population Health? ______2
What are Population Health Outcomes? important to separate outcomes from determinants of these outcomes. A separate blog collection goes into the outcome dimension much more fully ______3
What Are Population Health Determinants or Factors? produce population health outcomes______3
Population Health Policies and Programs ______4
Population Health: If It’s Everything, Is It Nothing? ___ 5
Obstacles to Population Health Policy: Is Anyone Accountable? ______5
Is Population Medicine Population Health? ______6
More Perspectives on Population Medicine Readers comment on the previous post ______6 RWJF Commission to Build a Is Population Health Finally Healthier America 2003 report on the social determinants of health. (I will return in a future Coming into Its Own? post to the challenge the social determinants of health pose still not matured in either scholarship or policy. However, the last several years have seen growing attention from a policy It is because I believe we are at a perspective. Here are some examples: “tipping point” in which a convergence of scholarship, policy, and practice initiatives seem poised to Dartmouth group bring an overdue population health perspective to thinking demonstrated how communities that spend the most on about and acting on health and health improvement. The health care may not have the highest quality or outcomes. challenge of the next decade will be to find practical ways in which new approaches to financial and non-financial Unnatural Causes incentives and multi-sectoral partnerships can be applied to provided wide exposure to the multiple determinants of health. improve population health outcomes here and elsewhere. major long term investment in the broad health of 10 communities in California. the 20th century was dominated by the rise of biomedical State science and clinical medicine. Many in public and population Health Improvement Plan to create “accountable health health (how are these different?) have been critics of the dominance of health care emphasis and investment, but these policy, systems, and environmental changes. advances have been critical and will continue to be so. The The Institute for Health Improvement has endorsed end of the century has seen additional growing understanding population health improvement as one of the three legs and support that such behaviors as tobacco use, diet, and of its Triple Aim strategy and is considering moving to a regional strategy of individuals and populations. My own population health epiphany came with my exposure in the early 1990s to the National Business Coalition on Health business-led health coalitions and the business sector on building the capacity of members to be leaders of health Research (1). At once simple and profound, it captured the reform and advance value based health and health care. basic population health principles: Concerns about obesity have underscored the complexity that health outcomes were more than the absence of tension between free will and the social context with regard disease; to behavior choices). that these outcomes were produced by complex interactions of multiple determinants (health care, “place-based” approach for social investments as well as behaviors, genetics, the social environment, the physical a major Community Health Data Initiative. environment); and National Priorities that in a resource-limited world, the relative cost Partnership are discussing the need for new broad effectiveness of these determinants was critical for measurement tools such as a national index of health. County Health Rankings of 3,014 counties in all 50 states according to a broad population health model that has been used in Wisconsin since 2003. been dominated by such issues as health care access and costs and pressing immediate public health issues Purchasing Population Health: Paying for Results in 1996, this list of activities was much shorter. Now and H1N1). Periodic activity and reports from government every day we learn of some new policy, practice, or research agencies and foundations have addressed parts of the broad issue of outcomes and determinants, but not in visible and sustainable ways. Notable exceptions have been (A) the guest posts from prominent policy and practice leaders. The University of Wisconsin Robert Wood Johnson Health and Health and Society Scholars Program Society Scholars Program will each month identify several to grow a new generation of multidisciplinary scholars for
7HAT IS 0OPULATION (EALTH s to policy, practice, or scholarship. All posts will in some way outcome measure, or policy intervention are relevant, and relate to our underlying population health model, including may even be critical in some cases--but they should be
Producing health, consuming What is the difference between population health health care. Social Science and Medicine, 31(12), 1347-63. and public health? Originally posted 5/18/10 The distinction between public health and population health deserves attention since it has been at times both
confusing and even divisive. Traditionally, public health has been understood by many to be the critical functions What Is Population Health? of state and local public health departments such as What is population health? encouraging healthy behaviors.
this blog is a broad one, as the model below offered by the Institute of Medicine reaches beyond this (1) illustrates [This model was adapted from the (2) and (3) ]. movement in “building a new generation of intersectoral partnerships that draw on the perspectives and resources the health outcomes of a of diverse communities and actively engage them in health group of individuals, including the distribution of such action(5) outcomes within the group.(3,4) These groups are often geographic populations such as nations or communities, but can also be other groups such as employees, ethnic groups, functions, since major population health determinants health outcomes of such groups are of relevance to policy resources provide inadequate support for traditional--let Note that population health is not just the overall health of a alone emerging--public health functions. Yet for those who health could be quite high if the majority of the population is relatively healthy—even though a minority of the population is much less healthy. Ideally such differences would be A Population Health eliminated or at least substantially reduced. Framework for Setting National and State Health Goals. JAMA, 299, 2081-2083. Producing Health, Consuming health determinants or factors, such as medical care systems, Health Care. Soc. Sci. Med. 33, 1347-1363. individual behavior, genetics, the social environment, and the physical environment. Each of these determinants has What is population health? a biological impact on individual and population health American Journal of Public Health, 93, 366-369. outcomes. Understanding Population Health Terminology. Milbank Quarterly, 85(1), 139-161. Isn’t this so broad to include everything? (5) Institute of Medicine. (2002). The Future of the Public’s Health in the 21st Century The National Academies as being so broad as to include everything—and therefore Press. Originally posted 5/18/10 truth is, no one in the public or private sectors currently has responsibility for overall health improvement. Policy managers, for example, tend to have responsibility for a single disease or factor.
The inherent value of a population health perspective is that
7HAT IS 0OPULATION (EALTH s What Are Population Health or geography. In the Health of Wisconsin Report Card, an overall grade for health disparity was given based on a Outcomes? Many health improvement models have multidomain disparity measure more fully. Understanding Population Health
Terminology. Milbank Quarterly, 85(1), 139-161.
A Population Health OUTCOMES DETERMINANTS/ Framework for Setting National and State Health Goals. JAMA, Mean Disparity FACTORS 299(17), 2081-2083. Race/Ethnicity Health Care (3) Healthy People 2010 SES Mortality Individual http://www. Geography Behavior healthypeople.gov. Accessed April 19, 2010. Gender Social A Environment Race/Ethnicity Glossary for Health Inequalities. Journal of Epidemiology and Health SES Physical Related Environment Community Health, 56:647–52. Quality Geography of Life Genetics Social Determinants and Their Unequal Gender Distribution: Clarifying Policy Understandings. Milbank Quarterly, 82(1):101–24. Grading and reporting health and health disparities. Preventing POLICIES and PROGRAMS Chronic Disease, 7(1). (7) Asada Y. A summary measure of health inequalities for a increasing overall or mean population health and eliminating disparities within the population. The outcomes component of 2010;7(4). http://www.cdc.gov/pcd/issues/2010/jul/09_0250. our population health model is shown in the left hand side of htm. Originally posted 5/18/10
displayed: mortality (length of life), and health-related quality What Are Population Health related quality of life as “a personal sense of physical and mental health and the ability to react to factors in the physical Determinants or Factors? health improvement is to increase years of life and the quality of those life years. measured, are produced by determinants Another goal is to reduce the differences or disparities in or factors. They often are sorted into the these health outcomes among different subgroups in the the following model- health care, in both mortality and health-related quality of life. Those OUTCOMES DETERMINANTS/ Mean Disparity FACTORS Race/Ethnicity Health gender, and geography. Many other subgroups besides Care SES these are associated with population health disparities. All Mortality Individual differences are not necessarily of policy interest or are equally Geography Behavior important in all situations. Gender Social Race/Ethnicity Environment Health SES Physical Related Environment Quality Geography of Life Genetics Gender The relative importance of each cell is not a research question but a value choice for different nations, states, or years of life and others more on the quality of those years. POLICIES and PROGRAMS
7HAT IS 0OPULATION (EALTH s individual behavior, social environment, physical environment, and genetics Health care determinants generally include Population Health Policies access, cost, quantity, and quality of health care services. Individual behavior determinants include choices about and Programs lifestyle or habits (either spontaneously or through response As the model below shows, policies and to incentives) such as diet, exercise, and substance abuse. programs play an important role in health social environment such as education, income, occupation, health factors as well as health outcomes. class, social support. Physical environment determinants include elements of the natural and built environment such as air and water quality, lead exposure, and the design of OUTCOMES DETERMINANTS/ neighborhoods. Genetic determinants include the genetic Mean Disparity FACTORS Race/Ethnicity Health composition of individuals or populations. Care SES Mortality Individual The subcomponents of these determinants or factors can Geography Behavior be measured in many different ways. The County Health Gender Social Rankings includes many such measures in each category Race/Ethnicity Environment Health that are available at the county level. A series of articles SES Physical Related Environment Quality commissioned by the MATCH project, to be published in the Geography of Life Genetics online journal Preventing Chronic Disease Gender measuring each of these categories.
In the model above, each category is depicted as the same POLICIES and PROGRAMS outcomes. Although useful for illustration, in reality those determinants will carry different weights (and hence would be for population health improvement creates an imperative studied, and because cross-sectoral analysis is complicated for focusing on those policies and programs that have been by interactions between determinants and the latency over shown to be most effective. However, because tight resources time of their effects. In the MATCH County Health Rankings, also limit the quantity and quality of evidence on any given health care is weighted 20%, behaviors 30%, the social policy or program, it can be very challenging for those environment 40%, and the physical environment 10%. An explanation of the process used to assign these particular online resources weights is available. However, determining the correct help point to recommended policies and programs. weights for each category and the policies and programs underpinning them remains a major challenge for population Policies can be implemented at many different levels, from an health research. and even the national level. Examples of effective health model going from outcomes to determinants/factors. menu labeling. There is an increasing call for a “health in all policies” approach among population health academic and practice leaders. Emerging in response to a growing example, childhood illness can be responsible for lower understanding and recognition of the many different factors outcomes and determinants are reversed; morbidity would be the determinant or factor and educational attainment the education, housing, transportation, agriculture, development, environment, and others to carefully examine the health implications of the policies they put into place. Originally posted 5/18/10 Programs aimed at population health improvement are extremely diverse and address the full range of health determinants/factors. They not only encompass efforts to improve access to health care and individual behavior but Originally posted 5/18/10
7HAT IS 0OPULATION (EALTH s Population Health: Obstacles to Population Health If It’s Everything, Is It Nothing? Policy: Is Anyone Accountable?
Population health policy has been slow to getting used to it from a career of more regarding community health improvement. our MATCH staff, have observed that the a response to the post on advance directives that “it could imply that everything is about population health (which, as you coming decade. multiple factors determining population health —health care, behaviors, genetics, social factors, physical environment, public health—can be seen population health model underpinning this blog and all as so broad as to be overwhelmingly inclusive and therefore resistant to realistic policy action or even scholarly analysis. perhaps everything: a broad set of outcomes produced by a activated by programs and policies in the public and private sectors. range of factors are spread across the public and private sectors (government at all levels, employers, health care micro-determinant or program/policy that theoretically and is no one actor or agent accountable and responsible for such actually has some detectable impact on population health broad population health outcomes as mortality, morbidity, and disparities. of program or policy of importance not only for this blog but In this resource-limited world, I believe the criterion should be largely based on economics, and in particular, the relative agencies to carry out their own essential services (much less effectiveness and cost-effectiveness of the determinant or the broader policies such as health care costs, early childhood program and policy on health outcomes. I have previously suggested mechanisms such as a public health “system”, this an easy exercise. Research is needed to explore the public-private partnerships, health outcomes trusts, and an effectiveness and cost effectiveness of broad policies and integrator function for healthcare organizations, none of programs designed to effect health improvement at the these mechanisms have been established beyond theory or probably have some marginal effectiveness but extremely low unique strengths and challenges across a broad spectrum of cost-effectiveness. health-related issues.
to guide population health improvement through resource weigh not only on available evidence on effectiveness and allocation and activities across multiple sectors and multiple and political supports and constraints. to address them. Thus, we focus on piecing together only Originally posted 8/9/10 etc.), while leaving – quite understandably --- perhaps more root cause and comprehensive solutions unaddressed.
7HAT IS 0OPULATION (EALTH s our definition of effort on a single or several initiatives. In fact, there is population health some evidence to support such an approach. As Conrad “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” Population health also encompasses the multiple implemented and managed by a small number of clearly determinants of health that produce these outcomes. community health improvement(1) The term population medicine has recently come into use. I was privileged to spend a few days last month in the Harvard world, implementation of a broader set of the most cost have defined effective interventions will be necessary to achieve the population medicine as “…the specific activities of the best outcomes. The 467 objectives in Healthy People 2010 medical care system that, by themselves or in collaboration with partners, promote population health beyond the goals equally important—which of course cannot be the case. of care of the individuals treated.” Much of the discussion Highest performance on an individual policy in a given community could become an end in itself rather than a means to the population health outcome goal. It is possible, I suppose, that each individual sector (health care, public Population medicine is primarily health, schools, employers) will arrive at the most robust concerned with clinical or health care determinants of health, set of cost effective investments and incentives possible (such as with public health, education, business, and social that available evidence suggests that “the broader the intervention focus and the more varied the target population, the more achievement of positive community health outcomes will depend on the integration of separate program part of the 2014 strategic planning process at HealthPartners components(1) board members to identify and commit to those traditional Hope remains, however, in the potential of cross-sectoral integrating mechanisms. To return to the title of this post, control (i.e., healthcare and health behavior). But they are I believe that no one entity today has accountability for problems both with individual sector solutions described above as well as multisectoral partnerships unless they partnerships with others to expand the scope of their can be brought to scale and demonstrate effectiveness. three-year goals were set for these partnership activities in the decades. same way as was done for the traditional health care cost and
( Community care networks: linking vision to population health being used to describe outcomes for community health improvement. Med Care Res the clinical, often chronic disease, outcomes of patients Rev enrolled in a given health plan. Certainly an enrolled patient group can be thought of and managed as a population, but Reorder 6/7/10 population health in terms of patient populations non-clinical factors such as education and income play in Is Population Medicine population medicine, and certainly is not appropriately termed population health Population Health? In a recent and very thoughtful policy paper for the National Quality Forum can sometimes mean different things and recommend that “current use of the abbreviated phrase to different people. This is currently the population health should be abandoned and replaced by case with both population medicine and the phrase total population health population health. will avoid confusion as the clinical care system moves rather swiftly toward measuring the health of the subpopulations
7HAT IS 0OPULATION (EALTH s areas are recommended when measuring total population health since funding decisions and regulations are inherently interventions and approaches that are evolving in parallel population medicine to across the country. George Isham, MD, MS participate and partner in improving total population health Paul, MN through a multi-sectoral approach to address broad health outcomes and disparity reductions. Originally posted 6/13/12 More Perspectives on
“Population Medicine” My previous post on population medicine prompted a number of thoughtful responses terminology discussion. The breadth of the population health view we espouse here can be undermined if it is confused with chronic disease management of enrolled patients. Emma Eggleston, MD, MPH Geoffrey Swain, MD, MPH Pilgrim Health Care Institute, Boston, MA
a healthcare system base. It encompasses the intersection care system are important and arguably easier to delineate address socioeconomic or physical environmental drivers and impact is in the intersection. Marc Gourevitch, MD, MPH would only note that the health care system is so strong and powerful that some special attention to the activities moving outside of the clinical arena is useful. This is not to diminish
7HAT IS 0OPULATION (EALTH s population health model from getting lost in translation. Originally posted 7/18/12
7HAT IS 0OPULATION (EALTH s Population Health Outcomes Table of Contents
What are Population Health Outcomes? ______9 Assessing Today’s Health...and Tomorrow’s __ 9 Which Outcomes Should We Improve? ______10 Is Chronic Disease Burden a Population Health Outcome? _ 11 Doing Well or Doing Better ______11 Which Health Disparities Do We Want to Reduce? ______12 Bending Health Disparity Curves each other? ______13 Population Health Disparities: Rates or Burden? issue ______14 IOM: Measurement for Accountability in Public Health expectancy for the United States ______14 The IOM Reports on Investing in a Healthier Future ______15 Population Health Targets: Unpopular But Needed ______16 What Are Population Health Outcomes? Understanding Population Health Terminology Milbank Quarterly A Population Health Framework for Setting National and State Health Goals JAMA, Healthy People 2010 OUTCOMES DETERMINANTS/ Mean Disparity FACTORS A Race/Ethnicity Health Care Glossary for Health Inequalities Journal of Epidemiology and SES Community Health Mortality Individual Geography Behavior Social Determinants and Their Unequal Gender Social Distribution: Clarifying Policy Understandings Milbank Environment Race/Ethnicity Quarterly Health SES Physical Related Environment Quality Geography of Life Grading and reporting health and health disparities Preventing Genetics Gender Chronic Disease POLICIES and PROGRAMS Originally posted 5/18/10
Assessing Today’s Health... and Tomorrow’s how population health is defined in their model, but America’s Health Rankings (AHR) and the County Health Rankings (CHR Health of Wisconsin Report Card,
0OPULATION (EALTH /UTCOMES s rates
OUTCOMES DETERMINANTS/ Mean Disparity FACTORS Race/Ethnicity Health Care SES Mortality Individual Geography Behavior Gender Social Race/Ethnicity Environment Health SES Physical Related Environment Quality Geography of Life Genetics Gender
POLICIES and PROGRAMS Originally posted 11/18/11 Which Outcomes Should We Improve?
determinants separate, since the former
0OPULATION (EALTH /UTCOMES s The National Research Council’s recent diverging paths in longevity among high- income countries time-delayed ripple of these “intermediate outcomes” or determinants affecting long-term health outcomes. ban smoking in 1,700 city parks and along 14 Originally posted 2/1/11 miles of beaches New York Times, the Is Chronic Disease Burden a Population Health Outcome? which outcomes we should improve The Institute of Medicine’s 2008 State of the USA Health Originally posted 2/8/11 (SUSA) Indicators report
Doing Well or Doing Better has been on outcomes, both long-term and intermediate One strategy might be to add a third category of and reward? What about communities and states that are
0OPULATION (EALTH /UTCOMES s which outcomes to target County Health Rankings of data to get an estimate for a single point in time change over time OUTCOMES DETERMINANTS/ Mean Disparity FACTORS Race/Ethnicity Health Care SES Mortality Individual Geography Behavior Gender Social Race/Ethnicity Environment Health SES Physical Related Environment Quality Geography of Life Genetics Gender
POLICIES and PROGRAMS The National Priorities Partnership of the National Quality Forum report on disparities and inequalities Originally posted 2/14/11 focused on the findings about racial disparities
Which Health Disparities Do We Want to Reduce? 2010 Health of Wisconsin Report Card multidomain disparity index
0OPULATION (EALTH /UTCOMES s Wisconsin Working-Age Adult Death Rates (Age 25-64, rates per 100,000 population) Non-urban (276) A B Whites Rural (272) (313) C D Suburban Men F (237) (357)
Women Milwaukee (220) County (396) some college (209) High school or less (437) Hispanic/Latino (192) Native 1000 College grads Americans (656) US Age Adjusted Mortality 0-74 by Race (180) 900 (1979-2007) Asians African Americans (652) (163) 800
700 100 200 300 400 500 600 700
600 best state Wisconsin worst state Minnesota (252) (289) Mississippi (530) 500 Black 400 White 300 200
has created many of the disparities in income, education, 100
0 1975 1980 1985 1990 1995 2000 2005 2010 900 US Age Adjusted Mortality 0-74 by Gender (1979-2007) 800 700
600 500 400 Females Males 300 Originally posted 2/22/11 200 100 0 1975 1980 1985 1990 1995 2000 2005 2010 Bending Health Disparity Curves raised the issue of disparities important issue for communities, states, and nations to specific quantitative targets for such improvement What Works for Health improve health reduce disparities differences are interesting and important, but not my point cessation may have the unintended effect of increasing disparities by socioeconomic status
0OPULATION (EALTH /UTCOMES s Indian or Alaska Native populations, will seldom be high resources we want to direct toward reducing disparities and reduction in total burden alone. An independent commitment to the goal to eliminate disparities would be required to warrant intervention with small racial and ethnic groups.” Originally posted 3/14/11 “sizable reductions in both disparity and total burden can result when the largest group has the worst rate and effective interventions are targeted to that group.” We need to engage in robust Population Health Disparities: Rates or Burden? In my March 14 post Bending Health Disparity Curves rates, such as deaths Originally posted 4/14/11
IOM: Measurement for Accountability in Public Health the Institute of Medicine (IOM) Committee on Public Health Strategies to Improve Health Mortality rate per 100,000* Population Size Black White Male Female For the
Public’s Health: The Role of Measurement in Action and Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Accountability Mortality File 1999-2007 there is a similarly large mortality gap in education Keppel and colleagues point out, “rates among small groups, such as the Asian and American
0OPULATION (EALTH /UTCOMES s call for broader use of comparative effectiveness research funding Recommendation: The Secretary of the Department of Health and Human Services should adopt an interim explicit life expectancy target, establish data systems for a permanent health-adjusted life expectancy target, and establish a specific per capita health expenditure target to be achieved by 2030. Reaching these targets should engage all health system stakeholders in actions intended to achieve parity with averages among comparable nations on healthy life expectancy and per capita health expenditures. Health Outcomes Trust Originally posted 5/10/11 The IOM Reports on Investing in a Healthier Future For the Public’s recommending that Congress double Health: Investing in a Healthier Future, the current federal appropriation for public health -- and make periodic adjustments to this appropriation based on the estimated cost of delivering the minimum package of public health services. focused on measurement of population health and related accountability at all levels of government Recommendation: The committee recommends that Congress authorize a dedicated, stable, and long-term legal and public policy reform financing structure to generate the enhanced federal revenue required to deliver the minimum package of public health services in every community. Such a financing
0OPULATION (EALTH /UTCOMES s structure should be established by enacting a national tax such targets; this is one reason our University of Wisconsin on all medical care transactions to close the gap between Population Health Institute Wisconsin currently available and needed federal funds. County Health Rankings Health of Wisconsin Report Card up by the Wall Street Journal debated in the coming months or years regarding whether it Healthiest Wisconsin 2020 State Health Plan does not Originally posted 4/19/12 a Triple Aim project integration that population health improvement requires Population Health Targets: Unpopular But Needed Originally posted 10/12/10 “A Population Health Framework for Setting National and State Health Goals.” Our recommendation was for a trend comparisons across other nations or states and be set
European target setting experience, one purpose of target setting is
0OPULATION (EALTH /UTCOMES s The Multiple Determinants of Population Health Table of Contents
What are Health Factors or Determinants? ______17 Is Lower Health Care Spending Good for our Health? The good news…and the bad ______17 Are We Individually Responsible for Our Health Behavior Choices? ______18 Have You Heard of “Primordial Prevention”? ___ 19 The Link Between Income and Health ______19 Will the Jobs Bill Impact Population Health? ______20 Peter Orszag Has It Half Right ______21 (How) Does Where You Live Get Under Your Skin? ______21 Is There Synergy In Community Development Financing and Population Health? ______22 Beyond Air and Water ______23 If Not Genetics, Then What? ______24 Can Our Environmental Stressors Be Inherited By Our Children? ______25 What are Health Factors or weights is available Determinants? OUTCOMES DETERMINANTS/ Mean Disparity FACTORS Race/Ethnicity Health Care SES Mortality Individual Geography Behavior Gender Social Race/Ethnicity Environment Health SES Physical Related Environment Originally posted 5/18/10 Quality Geography of Life Genetics Gender
Is Lower Health Care Spending
POLICIES and PROGRAMS Good for our Health?
Health care determinants Health Individual Affairs’ “Growth in U.S. Health Spending behavior determinants Remained Slow in 2010; Health Share of Domestic Product Was Unchanged From 2009.” This Physical environment determinants Genetic determinants County Health Rankings commissioned by the MATCH project Preventing Chronic Disease education leaders of major health care institutions are calling for increased social service expenditures County Health Rankings
The Multiple Determinants of Population Health s at local levels where such data is often not available Originally posted 2/21/12 Are We Individually Responsible for Our Health Behavior Choices? answer is often framed yes or no: either we Originally posted 11/10/10
The Multiple Determinants of Population Health s Have You Heard of “Primordial Prevention”? Originally posted 5/31/11 The Link Between Income and Health for the release of the 2012 County Heath Rankings Wisconsin County Rankings in 2003 Primordial prevention…aspires to establish and maintain conditions to minimize hazards to health…it consists of County actions and measures that inhibit the emergence and Health Rankings establishment of environmental, economic, social and behavioral conditions, cultural patterns of living known to increase the risk of disease. Disparities in premature mortality between high and low income U.S. counties Preventing Chronic Disease
The Multiple Determinants of Population Health s move on down the road toward better health locally customized policy approaches Originally posted 4/11/12
Will the Jobs Bill Impact Population Health?
elections often hinge on the state of the County Health Rankings’ Social and Economic Factors Healthy People 2020’s new section on the Social Determinants of Health
In a 2009 review, Bambra summarized: There are clear relationships between unemployment and increased risk of poor mental health and parasuicide, higher studies, a higher prevalence of risky health behaviours, including problematic alcohol use and smoking. The negative health experiences of unemployment are not limited to the unemployed only but also extend to families and the wider community…..links between unemployment and poorer health concepts: the material consequences of unemployment (e.g., wage loss and resulting changes in access to essential goods and services) and the psychosocial effects of unemployment
Sullivan and von Wachter (2009) among the many factors that determine how long (not to
The Multiple Determinants of Population Health s Bartley and Ferrie (2010) Lundin and colleagues (2010) estimated that 49% of the (Schmitz, 2011) Originally posted 9/22/11
Originally posted 10/26/10 Peter Orszag Has It Half Right (How) Does Where You Live A Health Plan for Colleges (New York Times Get Under Your Skin? an innovative housing project in the South Bronx that Issue Brief on Housing and Health
The Multiple Determinants of Population Health s the October 29 Economist! Jens Ludwig and colleagues New England Journal of Medicine Originally posted 11/2/11
Is There Synergy In Community Development Financing and
Population Health? with some incredulity – on the first Federal Reserve Healthy Communities Conference The Healthy Communities Initiative was created by the Healthy Communities: Building Systems to Integrate Community Development and Health Health Affairs Community Development and Health
The Multiple Determinants of Population Health s joint article: The community development ’industry’—a network of institutions, foundations, and government—draws on public Originally posted 11/9/11
such activity positively affects the ‘upstream’ causes of poor health, the community development industry rarely Beyond Air and Water collaborates with the health sector or even considers health effects in its work. Examples of initiatives—such as the creation of affordable housing that avoids nursing home the County Health Rankings and this blog collaborations to reduce health disparities and slow the growth of health care spending, while at the same time disadvantaged communities. Clinical Care
Health Affairs and the Kresge Foundation May 2011 issue
The Multiple Determinants of Population Health s treatment for leukemia approval in Europe of a gene therapy for treating a rare article “Sick Individuals and Sick Populations” in which he Originally posted 7/19/11
If Not Genetics, Then What? As Don Berwick says, “waste is theft.” Why Are Some People Healthy and Others Not: The Determinants of Health of Populations are some disorders where the inherited metabolic machinery Originally posted 9/4/12
ago after a series of New York Times articles on modern tailoring
The Multiple Determinants of Population Health s Can Our Environmental Stressors Be Inherited By Our Children? potential impact of modern genomics technology and venture capitalism could result in much waste, while less expensive investments we already know to be effective are ignored. The problem is that it is hard to predict the future, and decades from now there will certainly treatments and preventive interventions. We can only insist effectiveness be used to guide investments, rather than the few. When you have a mutation in a gene, you are stuck. You feel like you have a death sentence. There is no way of treating that unless you do gene therapy which has had very few References: medical successes to date. The epigenetic basis of health and Science/Technology disease might open up other routes of intervention. You might . develop drugs that target the epigenome to prevent or reduce susceptibility to disease; you might even leave drugs behind Epigenetic Influence of Social and treat yourself simply by varying your diet or the way you Experience Across the Lifespan Developmental live(1). Psychology Originally posted 11/7/12
The study of heritable changes in gene expression or cellular phenotype caused by mechanisms other than changes in the sequence. Conclusive evidence supporting epigenetics show that these mechanisms can enable the effects of parents’ experiences to be passed down to subsequent generations.
The Multiple Determinants of Population Health s Population Health Resources and Policy Table of Contents
Population Health Financing: Beyond Grants Poor population health is sapping our national productivity and quality of life. We need to go beyond grants ______26
Resources for Population Health Improvement: What About the Savings from Waste in Health Care? ______26 Where Would You Put the Money ______27
Modelling Long Run Costs and Outcomes ______28
A Population Health Opportunity Map _ 29 Do We Need Population Health Shock Therapy? ______30 Ignoring Evidence and Economics at Our Peril ______30 Do We Need a Population Health Super-Integrator? ______31 Locally Customized Population Health Policy Packages? ___ 32 Can We Find Political Common Ground to Improve Population Health? _ 32 Population Health Financing: Beyond Grants health goals. Originally posted 1/31/12
Resources for Population Health Improvement: What About the Savings from Waste in Health Care? The release of the national County Health Rankings productively on both the giving and receiving ends of this sustainability or going to scale. Medicine have been observing that 25% to 33% of all of our threefold regional variation in per capita Medicare or agricultural subsidies. . They have also our national productivity and quality of life. We need to go
Population Health Resources and Policy s References: Slowing the growth of health care costs—lessons from regional variation. The New England Journal of Medicine Realizing and allocating savings from improving health care quality and efficiency. Prev Chronic Dis cultures of cost effective practice have been developing for Waste in the U.S. health care system: A conceptual framework. The Milbank Quarterly Originally posted 5/17/10 Where Would You Put the Money These are only initial ideas and beginning steps; vast in order to avoid rationing health care…there is no reason to 2003 AJPH article (Consuming Research, Producing Policy?) used for another purpose health factor area and policy analysis on this question. The Trust for America’s Health (TFAH) estimated in 2008 Kim and Jennings found that at the challenge is to identify incentive structures and cross-sectoral practice. locally tailored “policy
packages”
Population Health Resources and Policy s simulation model which has been developed by the CDC over the past decade County Health Rankings encourage in the American Journal of Public Health Health Affairs three strategies over 10 and 25 years to reduce deaths and 1. 2. 3. Protecting health by enabling healthier behavior multisectoral super-integrators that can play a critical role in identifying and harnessing resources. lives and reduce costs by 62%. valuable population health resources. Originally posted 2/8/12 Modelling Long Run Costs and Outcomes and sensitivity analyses are usually required. The authors The broad population health model that underpins this blog and the County Health Rankings While the Health Affairs “Pathways Can We Afford to Wait for to Advantage” Better Evidence on Improving Child Health? and Business Investment in Early Childhood: Making Future Workers training. Happier more research which can better estimate such long-term impacts report on Public Health Measurement and Accountability HealthBound game 2011 Health Affairs discussed last week ocuses on the HealthBound policy
Population Health Resources and Policy s ReThink Health Initiative has begun to how this model can be applied to issue-specific clinical and community prevention efforts.
interview with Bobby Milstein about his article on . Originally posted 7/27/11
A Population Health Opportunity Map
May 25 JAMA by effectiveness. other. pictured above at right. question directly. Originally posted 8/9/11
Population Health Resources and Policy s Do We Need Population Health Shock Therapy? That Used To Be Us: How America Fell Behind in the World It Invented and How We Can Come Back 1. including disparity reduction. 2. 3. 4. Identify cross-sectoral national and local partnership leverage additional resources and policies.
Originally posted 10/5/11 political paralysis is not up to these challenges and that the Ignoring Evidence and a radical centrist third party. Economics at Our Peril New York Times articles the recommendation by the U.S. Preventive Services Task Force to forego routine screening for prostate cancer with the PSA test costs should explicitly gender. be considered in deciding what benefits must be provided by insurance plans In discussing this blog and the challenges of its having
Population Health Resources and Policy s considered ineffective; as Minneapolis but gets no better results; Any mention of this triggers loaded words from “rationing” Super-Integrator New York Times article asserted Employers and Community Organizations
Healthcare Government and Organizations Schools Prevention and Public Health Fund); Centers for Medicare and Medicaid Services (CMS). “shock therapy” Originally posted 10/11/11
Do We Need a Population Health Super-Integrator?
Population Health Resources and Policy s regarding cost-effectiveness beyond effectiveness itself. It is functions. Originally posted 9/14/10 particularly disparity reduction. Locally Customized Population Health Policy Packages? guidance to ensure that local level health Originally posted 8/31/11 County Health Rankings Can We Find Political Common Ground to Improve Population Health? Would it be helpful to identify a set of Population Health That Used To Be Us: How America Fell Behind in the World It Invented and How We Can Come
Population Health Resources and Policy s Back The Righteous Mind: Why Good People are Divided by Politics and Religion. Haidt is this provocative area. Originally posted 9/14/12
He argues that these different foundations have a partial
liberal and conservatives relating to sensitivity to threats and He argues that this produces a conservative advantage
Population Health Resources and Policy s FOR FURTHER INFORMATION CONTACT: improvingpopulationhealth.org David A. Kindig